EPSRC-NIHR HTC Partnership Award: IMPRESS Network, Incontinence Management and Prevention through Engineering and Sciences

Lead Research Organisation: University of Leeds
Department Name: Mechanical Engineering

Abstract

Faecal Incontinence (FI) is defined as the inability to fully control the passage of faeces through the anus. This may arise due to a weakened anal sphincter muscle (typically following child birth), problems with nerve supply (e.g. stroke, multiple sclerosis), or in association with other gastrointestinal conditions (e.g. irritable bowel syndrome). It is a common and distressing condition that causes shame, embarrassment, depression, social isolation, secrecy, poor self-esteem, and sexual avoidance. As a result, more than 54% of patients with FI have not discussed their symptoms with a physician , and only one-quarter of patients with FI are referred by their GP for specialist treatment . Its exact prevalence is difficult to determine but best estimates suggest that in the adult population it is around 10%, and that 0.5% - 1% below 65 years and 3% - 8% over 65 years experience regular faecal incontinence. Urinary Incontinence (UI) is defined as involuntary leakage of urine, UI presents a major burden on NHS resources. It is a common and distressing condition, which impacts of quality of life. The main forms of UI are stress incontinence (SUI), which is leakage with physical exertion, and urge incontinence (UUI), which is leakage with a strong desire to void. Mixed urinary incontinence is a combination of SUI and UUI. The prevalence of UI increases with age and is higher in institutionalised adults, who tend to be older and suffer associated co-morbidity. It is more often a problem for females, with prevalence rates of UI ranging from 4.5% to 53% in women, as compared to 1.5% and 24% in men. Although previously considered in isolation, it is increasingly recognised that many forms of FI and UI share a common underlying pathophysiology and frequently co-exist with pelvic organ prolapse

Incontinence places a massive burden on the NHS and impacts significantly on quality of life for thousands of patients in the UK. Whilst many areas of medical engineering share a growth in the engagement of engineers and scientists to push forward the exploitation of emerging technologies it is arguably the case that the nature of this disease prevents engineering and science research leaders seeing the potential for some rich research challenges. This proposed network will provide a step change in the increased engagement of leading UK technologists (from academia and industry) to provide a substantial impact to incontinence sufferers.

Planned Impact

Impact from the IMPRESS Network will be achieved primarily through establishment of better channels of communication between researchers in the engineering and physical sciences, persons affected by incontinence and their healthcare providers, and industry. In doing so, it will resolve the current impasse that stifles innovation and translation of new engineering technologies for the management, treatment and prevention of incontinence.

Knowledge: Technology & scientific advances - Research challenges identified by the Network will be disseminated via academic publications in open access journals, as well as the IMPRESS interactive website and webinars. The Incontinence Technology Advocates will disseminate the Network's outputs at scientific and clinical research meetings, especially those covering technology areas capable of addressing the clinical/engineering challenges identified by the Network. The Network will actively seek to disseminate its progress and findings to other users in the healthcare service via the activities of the three affiliated HTCs (Colorectal Therapies, Enteric, and D4D), via their websites and emailed newsletters.
Society: The Patient Focus Groups to be engaged with during Stage III of the Network will provide direct discourse between the research community and persons in society affected by incontinence. The geographical spread of clinical and patient participants from across the UK will ensure the composition of the Network will be balanced to reflect the variety of affected persons from mixed ages, ethnic, and social groups. Patient feedback from the Focus Groups will be particularly important for gaining the views and opinions of persons affected by different aspects of incontinence.
Policy - The Network will address a significant unmet medical need and is aimed at providing an impetus to invest and create new disruptive engineering technologies for this rarely mentioned but highly prevalent conditioned. The Network will work with the International Longevity Centre-UK (ILC) and the All Party Parliamentary Group for Continence Care to disseminate, promote and implement its findings into future healthcare and social policies.

People: Skills-Through the planned 'learning and information exchange sessions', scientists will be educated by healthcare providers and patients about the causes and medical needs that currently exist for persons affected by incontinence. The 'Incontinence Technology Advocates' will serve as a conduit between clinicians/surgeons/patients and the wider scientific community, which will help with technology development, especially how patients' needs can be fed into the design and development stages of new technologies

Economy: Wealth creation-Incontinence is a relatively unexploited clinical condition that offers significant opportunities for academic-industrial collaboration and subsequent value for commercial exploitation.

Once a list of research challenges for the Network has been identified, industrial partners for each of these will be sought to facilitate future development. Identification of industry partners will be facilitated through liaison with the Knowledge Transfer Network, TSB Catapult Centres in High Value Manufacturing and Cell Therapy, and the Industrial Partnerships Group/Translational Research Office at UCL.

Publications

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Brouillard CBJ (2019) Suppression of Urinary Voiding "on Demand" by High-Frequency Stimulation of the S1 Sacral Nerve Root in Anesthetized Rats. in Neuromodulation : journal of the International Neuromodulation Society

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Mancuso E (2020) The use of polymeric meshes for pelvic organ prolapse: Current concepts, challenges, and future perspectives. in Journal of biomedical materials research. Part B, Applied biomaterials

 
Description The IMPRESS network was designed to have two phases, 'Knowledge Building' followed by 'Network Expansion'. We are now moving into the latter, having achieved our goals in the first phase; our key activities and their resultant output are described below (a full list is available on the IMPRESS website, www.impress-network.com):

*Knowledge Building
During its first year the IMPRESS network has instigated and maintained an ongoing series of activities to train its IMPRESS Incontinence Technology Advocates (TAs) (experts from the science and engineering community) in the clinical challenges faced in the area of incontinence:
• IMPRESS Knowledge Building Workshop: a 2 day event at St James's Hospital Leeds as an introduction to the current clinical treatments for incontinence, delivered by a team of 15 clinicians, 4 industry reps and 3 patients. Output: Trained and engaged 15 IMPRESS TAs to build the network
• IMPRESS Healthcare Professional Shadowing held between our TAs and 9 specialist healthcare professionals to identify differing conditions and the technological interventions currently used to address them. Output: 8 detailed case-studies made publically available through the IMPRESS website covering specialities including surgery, radiology, nursing and rehabilitation. Dr Culmer (PI) has been awarded funding from the ISSF Wellcome scheme to continue this work in more detail.
• IMPRESS Focus Workshop: held at UCL with clinicians, PPI reps, IMPRESS TAs and HTC links, brought together to review some of the emerging technologies in science and engineering and brainstorm how they could be applied to incontinence unmet needs. Output: The first round of IMPRESS Pilot Projects was opened for proposals (detailed below) and our network was expanded to 20 TAs.

*Network Building and Dissemination
We have actively worked to expand the IMPRESS network and disseminate using online media (via the IMPRESS website, Twitter account and LinkedIn Group) together with targeted activity through the TAs:
• Scientific Meetings: We have promoted IMPRESS at key scientific and healthcare events including; the influential 'Innovating for Incontinence' 2015 conference, ERIC/PROMOCON Symposium 2015, the EMBC Medical Engineering 2015 and OUTLOOK™ 2014. Output: Significant interest generated has led to new collaborations with industry (Novuqare Ltd. Uroglide), invited talks (PROMOCON 2016, Incontinence: the Engineering Challenge X) and links to researchers and clinicians (i.e. Prof. Lovick, Prof. Dogramadzi)
• Industry Engagement: Through our HTC network partners we have conducted specific meetings with key industry partners related to incontinence healthcare (American Medical Systems, Coloplast, Olympus Medical). Output: Expansion of industry involvement in the network, foundations for new collaborative projects (to target our 2nd round of pilot projects) and an industry-supported PhD project with University of Leeds and Olympus (starting Oct 2015).
• PPI involvement: We have engaged with patient groups through our HTC partners (and related events), at scientific meetings (see above) and in public forums (IMPRESS promotion at St James' Hospital, Leeds during World Continence Week 2015). We are running patient-specific IMPRESS events over the next 6 months, starting with the 'IMechE Incontinence' event (Nov 2015). Output: Our direct patient network has expanded, together with additional links to key patient-advocacy groups (i.e PROMOCON and ERIC) enabling us to engage more effectively with these end-users.
• Policy and Strategy: We have exploited our network contacts to engage with policy makers related to incontinence care and treatment. We have outlined IMPRESS to the UK All Party Parliamentary Group For Continence Care and are collaborating with the International Longevity Centre (a Think-Tank dedicated to addressing challenges of aging, including incontinence, to inform decision making in government). We collaborate closely with our HTC partners with their links to clinical and regulatory bodies. Output: We are scheduled to update the UK All Party Parliamentary Group For Continence Care and present our work at HTC events in 2015 and 2016. Dr Culmer has been sponsored as a member of ICI-RS and attended their Annual Meeting on Policy.

*Pilot Projects
Our IMPRESS Focus Workshop launched a competition to award pump-prime funding to five pilot projects which foster new collaboration and develop ideas for applying the latest technologies to create novel incontinence devices, products and treatments. This first-round of projects was clinically driven and features extensive collaboration between partner institutes, helping to broaden expertise within the network.
• "Tactile Sensing Capsule for Assessment of Incontinence", Prof S. Dogramadzi, Bristol Robotics Lab; this project will adapt robotic sensing technology to objectively assess pelvic floor dysfunction.
• "Smart-Plug: Diagnostic System", Dr M. Oldfield, Mechatronics in Medicine Lab, Imperial College; this project will develop an active physical model of the anal sphincter system. This advanced simulation system will be used for device development (with Bristol) and clinical training.
• "Biotribology of Incontinence Management Products", Dr M. Bryant, Engineering, Leeds; this will characterise the tribological properties of commercially available incontinence products to understand how they can be optimised through surface treatments
• "A fat chance of curing incontinence", Dr R. Day, UCL; this will explore the efficacy of tissue engineering approaches to augment the pelvic floor and improve continence.
• "Pelvic nerve stimulation to control urinary continence", Prof. T. Lovick, University of Bristol; evaluating a novel electrical stimulation technique of the pelvic nerve for urinary urge incontinence.

*Technology Transfer and Collaboration
We have actively engaged with our HTC partners throughout the IMPRESS project as our primary mechanism for technology transfer and clinical/industry collaboration. This has included maintaining an active presence at HTC events (i.e. the National HTC in Colorectal Therapies meeting 2014, 2015) together with regular interaction between the management committees. This has been a true collaboration benefiting all parties, for example IMPRESS identified links relevant to the HTCs (i.e. Queens University Belfast and the Uroglide project, now in discussions with D4D on future collaborations). Similarly we have received valuable input from the HTCs (i.e. PPI links to steer research at HTC meetings).
Exploitation Route We are regularly disseminating our findings from IMPRESS workshop events, research and network collaborations to inspire and inform future research in the area.

Our pilot funding scheme is linked to clinical and patient feedback and will lead to further funding applications to RCUK and other funding bodies.
Sectors Digital/Communication/Information Technologies (including Software),Electronics,Healthcare,Manufacturing, including Industrial Biotechology,Pharmaceuticals and Medical Biotechnology

URL http://www.impress-network.com
 
Description This original IMPRESS Network grant has directly led to the extended IMPRESS Plus project which extended our original remit, with provided an increased scope (to expand the network internationally), enhanced funding to increase research activity, and enabled us to continue disseminating our work for public and patient benefit. A key long-term outcome has been to support and develop the IMECHE's Incontinence: The Engineering Challenge Conference - the only Engineering/Physical Sciences conference globally to address incontinence and the challenges raised by this condition. The event continues to catalyse research activity in this neglected area and raise the profile of the condition, and need for engineering innovation to address it's challenges. The next event will be held in November 2021 (linked below) and be followed by promotional events to disseminate outcomes to the public. https://events.imeche.org/ViewEvent?code=CON7265
First Year Of Impact 2016
Sector Healthcare
Impact Types Societal,Economic,Policy & public services

 
Description Presentation to APPG Continence Care
Geographic Reach National 
Policy Influence Type Participation in a guidance/advisory committee
 
Description AMELIE (Anchored Muscle cELls for IncontinEnce)
Amount € 952,609,725 (EUR)
Organisation European Commission H2020 
Sector Public
Country Belgium
Start 08/2020 
End 08/2025
 
Description GSK Innovation Challenge
Amount $1,000,000 (USD)
Organisation GlaxoSmithKline (GSK) 
Sector Private
Country Global
Start 09/2015 
End 11/2016
 
Description IMPRESS Follow on awards
Amount £10,000 (GBP)
Organisation University of Leeds 
Department IMPRESS
Sector Academic/University
Country United Kingdom
Start 09/2016 
End 04/2017
 
Description IMPRESS proof of concept
Amount £3,000 (GBP)
Organisation University of Leeds 
Department IMPRESS
Sector Academic/University
Country United Kingdom
Start 09/2015 
End 04/2016
 
Description Collaboration with NIHR Colorectal Therapies Healthcare Technology Co-operative (HTC) 
Organisation National Institute for Health Research
Department Healthcare Technology Co-operatives (HTCs)
Country United Kingdom 
Sector Public 
PI Contribution We have been working with the Colorectal Therapies HTC, in developing the Intra-Abdominal Platform.
Collaborator Contribution The HTC help us by arranging access to surgeons for feedback on the device, access to their network, giving our device publicity, and by advising us on commercial strategy.
Impact A consultation with a group of around 8 surgeons resulted in essential feedback, in April 2015. A presentation we gave on the device at the HTC national meeting resulted in interest from a company, in November 2015. This collaboration is multi-disciplinary: the disciplines involved are clinical advice, business management, marketing, product design, and mechanical engineering.
Start Year 2015
 
Description Collaboration with NIHR D4D 
Organisation National Institute for Health Research
Department NIHR Devices for Dignity Healthcare Technology Co-Operative
Country United Kingdom 
Sector Public 
PI Contribution Our collaboration with D4D stems from our complementary aims. We have worked together to 1) share our network contacts to broaden and strengthen both networks 2) identify excellent research/projects and identify how best to support these 3) run and plan joint research/ PPI events
Collaborator Contribution See above
Impact D4D have been actively involved in developing our IMPRESS funding scheme and are board members of IMPRESS Plus.
Start Year 2015
 
Description Enteric Collaboration 
Organisation National Institute for Health Research
Department Enteric Healthcare Technology Co-operative
Country United Kingdom 
Sector Public 
PI Contribution We have worked with Enteric to identify and support complementary research activities in the clinical area of incontinence. Enteric are a formal member of the IMPRESS Plus board and supported the funding application for IMPRESS Plus
Collaborator Contribution See above
Impact Enteric have helped guide the research direction of IMPRESS, bringing clinical insight to the steering committee
Start Year 2015
 
Description Colorectal Therapies HTC National Meeting 2015 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact We presented on the Intra-Abdominal Platform at this event, to around 200 people. Following it, we received contact from a company interested in potentially taking a licence of our IP.
Year(s) Of Engagement Activity 2015
URL http://colorectal.htc.nihr.ac.uk/upcoming-meetings/national-meeting-2015/
 
Description Discussion ThinkTank: Refractory OAB and idiopathic urinary retention: can phenotyping improve outcome for patients? 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact International Consultation on Incontinence Research Society, Bristol, ThinkTank on 'Refractory Over Active Bladder and idiopathic urinary retention: can phenotyping improve outcome for patients?' This was one of a series of discussion meetings to identify outstanding questions and research questions.
Year(s) Of Engagement Activity 2019
 
Description ERIC Bed Wetting Workshop 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Patients, carers and/or patient groups
Results and Impact IMPRESS project manager activity participated in this workshop with industry about a potential mobile app for children with nocturnal enuresis. Strengthened links with ERIC who are one of our charity partners and also led to sponsorship of a future IMPRESS event (Symposium 2016) from Digital Creativity in Disability who were developing the app.
Year(s) Of Engagement Activity 2016
URL http://digitalcredis.co.uk/
 
Description ICI-RS Scientific Meeting 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Think tank type event for researchers specialising in incontinence aimed at promoting new ideas for improving treatment of incontinence. Participation at this event led to expansion of our IMPRESS network - new members from Bristol University, who then applied to our Proof of Concept Funding Call and we funded their pilot work on pelvic nerve stimulation for treating urinary incontinence in 2015/6 plus follow on studies starting in 2017.
Year(s) Of Engagement Activity 2015
URL http://www.ici-rs.org/downloads/Programme%20with%20chairs%20for%206th%20ICI-RS%202015.pdf
 
Description IMECHE Incontinence the Engineering Challenge X 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact This is the UK'S only engineering and incontinence focussed event. it takes place biennially. IMPRESS sponsored this event and through poster presentations and an exhibition stand we were able to expand our network particularly with patient contacts who we were able to attract to a future IMPRESS PPI workshop on Faecal Incontinence planned for the following year.
Year(s) Of Engagement Activity 2015
URL http://events.imeche.org/ViewEvent?code=C6177
 
Description IMPRESS Knowledge Building Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact A three day workshop run by IMPRESS to educate engineering researchers on the clinical challenges of diagnosing, treating and managing incontinence, through a range of presentations and hands on tutorials from specialists healthcare practitioners to explain the current methods, plus sessions from patients explaining the difficulties of living with incontinence. This event established our initial IMPRESS network membership which ahs since grown to ~250.
Year(s) Of Engagement Activity 2014
 
Description IMPRESS PPI Workshop on Faecal Incontinence 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact A one day workshop focussing on group sessions with patients, focussing on their specific needs for improving how their Faecal Incontinence is managed/treated. This event led to production of an infographic which summarised the output from those sessions to our network and publically (through social media). The output in turn helped IMPRESS to reshape it's future strategy for the remainder of the term.
Year(s) Of Engagement Activity 2016
URL https://www.eventbrite.co.uk/e/impress-end-user-technology-workshop-faecal-incontinence-tickets-1963...
 
Description IMPRESS Symposium 2016 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact A one day event focussing on showcasing next generation technologies applied to incontinence. This network wide event was aimed at encouraging new ideas and research collaborations and provided a platform to announce our IMPRESSplus Funding Call 2016. As a result we had more applications than expected and granted all 3 awards.
Year(s) Of Engagement Activity 2016
URL https://www.eventbrite.co.uk/e/symposium-next-generation-technologies-for-incontinence-tickets-23229...
 
Description IMPRESS Technology Focus Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The aim of this workshop was to brainstorm the novel application to new engineering technologies to address the clinical challenges of incontinence. The one day event helped to set ideas in the minds of our network members and provided a platform for IMPRESS to open it's first Proof of Concept Funding Call from which five projects were funded in 2015/16.
Year(s) Of Engagement Activity 2015
 
Description Invited speaker 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact . High frequency stimulation of the pelvic nerve or S1 sacral nerve root to inhibit urinary voiding -which is best? Science in Urology satellite meeting of ICI-RS Bristol, June 2019.
Year(s) Of Engagement Activity 2019
 
Description Leeds Teaching Hospitals Catheter Open Day 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Presented IMPRESS activities to specialist nurses and patient and industry representatives. This led to the expansion of our IMPRESS network - more specialist nurses joined.
Year(s) Of Engagement Activity 2016
 
Description Mutli-disciplinary Student Internship project 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact This activity was a summer student project related to developing a new mesh material for treating incontinence in-vivo. It aimed to bring together students at the University of Leeds studying medicine, engineering, and chemistry to work with the textiles faculty in a multi-disciplinary exercise developing research ideas across the disciplines.
Year(s) Of Engagement Activity 2016
 
Description Promocon (Bladder and Bowel UK) Symposium 2016 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact IMPRESS presented their activities to a large audience of Healthcare practitioners. Through this activity Bladder and Bowel UK have become one of our charity partners we are developing further ideas on how we might collaborate further to highlight the need to improve treatments for incontinence.
Year(s) Of Engagement Activity 2016
URL http://www.bladderandboweluk.co.uk/
 
Description Shadowing sessions with Healthcare Professionals 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact A series of shadowing sessions with specialist healthcare professionals where a group of engineering researchers from the University of Leeds met with each specialist to gain a more detailed understand of the procedures and devices they use in treating patients with incontinence. This helped the researchers to develop their own research ideas around the incontinence theme and it also served as an information tool for our wider network, delivered through our website resources. Engagement with the following practitioners took place during the course of 2014: 1) Gastro-intestinal Physiologist at Leeds General Infirmary, 2) Urologist at St James's Hospital Leeds, 3) Colorectal Surgeon at St James's Hospital Leeds, 4) Anatomy Clinician at St James's Hospital Leeds, 5) Rehabilitation Clinician at Leeds General Infirmary, 6) Urologist at Pinderfields Hospital, Wakefield, 7) Radiologist at St James's Hospital Leeds, 8) Specialist Bladder and Bowel Nurse at Leeds Community Health NHS Trust.
Year(s) Of Engagement Activity 2014
URL http://impress-network.com/clinical-experience/
 
Description Simon Foundation Innovating for Continence Conference 2015 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This is a biennial high profile incontinence international conference in USA. Poster presentation at this conference has led to collaboration with Novuqare BV as an industry partner who came on board officially when IMPRESS received follow-on funding from EPSRC in 2016.
Year(s) Of Engagement Activity 2015
URL http://www.innovatingforcontinence.org/2015_conference.html
 
Description Urinary catheters - not just uncomfortable but dangerous too 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact News article concerning research developments in the area of urinary incontinence technologies at 'theconversation.com'
Year(s) Of Engagement Activity 2020